DESCRIPTION: In response to a growing awareness of violence against health care workers, the State of California implemented two initiatives to reduce workplace violence in health care facilities. The first initiative was Cal/OSHA's 1993 release of "Guidelines for Security and Safety of Health Care and Community Service Workers." These Guidelines describe elements of a comprehensive security program for the health care setting. The second initiative was the California Hospital Safety and Security Act (Assembly Bill 508), which required licensed acute care and psychiatric facilities to implement a comprehensive security program by July, 1995. The combination of these two initiatives is unique among states, and no formal evaluation of either of these initiatives has been conducted. The overall goal of this proposed research is to apply a quasi-experimental study design to evaluate the simultaneous effects of these two initiatives. The first objective is to conduct an impact evaluation to determine if the initiatives led to improved security programs in California hospitals. The second objective is to conduct an outcome evaluation to determine the effects of the two initiatives on incidence rates of violent events in hospitals. Psychiatric and Acute Care Hospitals in California will comprise the intervention population and those in New Jersey will comprise the comparison population. New Jersey was chosen as the comparison state because they follow Federal OSHA Guidelines and have no specific state-based initiatives regarding hospital security programs. At least 150 intervention and 50 comparison hospitals will be sampled using a stratified random sampling method to represent urban influence and hospital size. A comprehensive evaluation of security programs will be conducted through the review of safety program material and interviews with the Nurse Managers, Risk Managers and an average of three staff members within each unit. The security assessment will evaluate environmental modifications, work practice changes, policies and practices implemented, training, security services, management commitment, use of risk assessment, and violent event surveillance. Incident rates of violent events in participating facilities will be the main outcome measure. An interrupted time-series analysis will be used to determine if the initiatives led to decreases in rates when compared to the comparison hospitals. The relationship between different components of the security programs and violent event rates will also be examined. This proposal is a unique opportunity to examine the impact of state-based prevention initiatives and to identify the most effective components of hospital security programs. Such evaluations have been identified as a priority in research agendas including NORA and Workplace Violence: A Report to the Nation.